Virginia M. Molleran MD, Presenter: Speakers Bureau, SenoRx, Inc

Mary C. Mahoney MD, Abstract Co-Author: Consultant, Johnson & Johnson Speakers Bureau, Johnson & Johnson Consultant, SenoRx, Inc Speakers Bureau, SenoRx, Inc Scientific Advisory Board, Hologic, Inc

The purpose of this study was to determine the incidence of malignancy or high risk pathology in lesions initially diagnosed as benign papillomas at core needle biopsy in order evaluate to the need for subsequent surgical excision.

We conducted a search of our institution’s breast biopsy data base for all lesions diagnosed as benign papillary lesions at core needle biopsy. Subsequent breast imaging, surgical and pathologic records for these patients were reviewed. Only those lesions that had undergone surgical excision or at least 2 year imaging follow-up were included. Lesions that had associated high risk pathology or malignancy were excluded

Our search yielded 168 lesions in 158 patients. 55 lesions did not meet the inclusion criteria and were excluded. This left a study population of 113 biopsies in 106 patients. Included in our study were biopsies showing papillomatosis or papillary hyperplasia (n = 9), and cases with findings suggestive of multiple peripheral papillomas (n = 23). 103 (90.4 %) biopsies were performed with vacuum assisted 11g or larger needles. The remainder were performed with 14g spring loaded needles. There were 5 malignancies (4.4%): 1 intracystic papillary carcinoma in situ, and 4 cases of DCIS. High risk pathology was seen at surgical excision in 11.4%. There were no cancers or high risk lesions in 9 patients with papillomatosis or papillary hyperplasia. When pathology results were suggestive of multiple peripheral papillomas, cancer was seen in 1 of 23 (4.3%) and high risk pathology in 6 (26.1%).

The upgrade rate of 4.4% in our study does not meet criteria for a probably benign lesion (2% malignancy rate) and supports the need for excisional biopsy. No cancers were seen in patients with papillomatosis or papillary hyperplasia in our study, and these patients can likely undergo imaging follow up. The relatively high prevalence of associated high risk lesions at surgical excision suggests the need for close surveillance of these patients. The upgrade rate did not vary substantially when the initial pathology was suggestive of multiple peripheral papillomas.

Excisional biopsy is recommended for benign papillomas diagnosed at core needle biopsy, while papillomatosis can undergo imaging follow up.  

Molleran, V, Mahoney, M, Incidence of Malignancy or High Risk Pathology in Benign Papillomas Diagnosed at Core Needle Biopsy.  Radiological Society of North America 2009 Scientific Assembly and Annual Meeting, November 29 - December 4, 2009 ,Chicago IL. http://archive.rsna.org/2009/8004647.html